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Graft-Versus-Host Disease

Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease

Bone Marrow Transplantation volume 38, pages 629–633 (2006)Cite this article

Abstract

It has previously been shown that enteral nutrition has several advantages compared to parenteral nutrition (PN) in critically ill patients. The nutritional history was studied in 231 patients after allogeneic stem cell transplantation (SCT). Parenteral nutrition was given for a median of 10 (0–74) days. Patients with graft-versus-host disease (GVHD) grades III–IV received more PN (median 20, range 0–67) than patients with GVHD grades 0–II (10, 0–74, P=0.016). Eighty-five (37%) patients were not able to eat anything for a median of 4 days (1–37). We found a correlation between the number of days with no oral intake (before the diagnosis of acute GVHD) and the incidence of acute GVHD grades III–IV. In patients with 1–4 days of no oral intake, the incidence of grades III–IV acute GVHD was 6%, in those with 5–9 days it was 17%, and in those with >9 days it was 38%. On multivariate analysis, we found that more than 9 days with no oral intake was associated with acute GVHD grades III–IV (odds ratio 7.66, confidence interval 1.44–40.7, P=0.016). Poor oral intake early after SCT may be associated with an increased risk of developing severe acute GVHD.

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References

  1. Ringden O, Deeg J . Clinical spectrum of graft-versus-host disease. In: Ferrara J, Deeg J, Burakoff S (eds). Graft-Vs-Host Disease. Marcel Dekker Inc.: New York, 1996, pp 525–560.

    Google Scholar 

  2. Vogelsang GB, Lee L, Bensen-Kennedy DM . Pathogenesis and treatment of graft-versus-host disease after bone marrow transplant. Annu Rev Med 2003; 54: 29–52.

    Article  CAS  PubMed  Google Scholar 

  3. Hill GR, Ferrara JL . The primacy of the gastrointestinal tract as a target organ of acute graft-versus-host disease: rationale for the use of cytokine shields in allogeneic bone marrow transplantation. Blood 2000; 95: 2754–2759.

    CAS  PubMed  Google Scholar 

  4. Horsley P, Bauer J, Gallagher B . Poor nutritional status prior to peripheral blood stem cell transplantation is associated with increased length of hospital stay. Bone Marrow Transplant 2005; 35: 1113–1116.

    Article  CAS  PubMed  Google Scholar 

  5. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992; 215: 503–511; discussion 511–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sigalet DL, Mackenzie SL, Hameed SM . Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma. Can J Surg 2004; 47: 109–116.

    PubMed  PubMed Central  Google Scholar 

  7. Svahn BM, Remberger M, Myrback KE, Holmberg K, Eriksson B, Hentschke P et al. Home care during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation is advantageous compared with hospital care. Blood 2002; 100: 4317–4324.

    Article  CAS  PubMed  Google Scholar 

  8. Ringden O, Baryd I, Johansson B, Gahrton G, Groth CG, Lundgren G et al. Increased mortality by septicemia, interstitial pneumonitis and pulmonary fibrosis among bone marrow transplant recipients receiving an increased mean dose rate of total irradiation. Acta Radiologica – Oncology 1983; 22: 423–428.

    Article  CAS  PubMed  Google Scholar 

  9. Oakhill A, Pamphilon DH, Potter MN, Steward CG, Goodman S, Green A et al. Unrelated donor bone marrow transplantation for children with relapsed acute lymphoblastic leukaemia in second complete remission. Br J Haematol 1996; 94: 574–578.

    Article  CAS  PubMed  Google Scholar 

  10. Ringden O, Remberger M, Ruutu T, Nikoskelainen J, Volin L, Vindelov L et al. Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukaemia. Nordic Bone Marrow Transplantation Group. Blood 1999; 93: 2196–2201.

    CAS  PubMed  Google Scholar 

  11. Remberger M, Svahn BM, Hentschke P, Lofgren C, Ringden O . Effect on cytokine release and graft-versus-host disease of different anti-T cell antibodies during conditioning for unrelated haematopoietic stem cell transplantation. Bone Marrow Transplant 1999; 24: 823–830.

    Article  CAS  PubMed  Google Scholar 

  12. Ringden O, Horowitz MM, Sondel P, Gale RP, Biggs JC, Champlin RE et al. Methotrexate, cyclosporine, or both to prevent graft-versus-host disease after HLA-identical sibling bone marrow transplants for early leukemia? Blood 1993; 81: 1094–1101.

    CAS  PubMed  Google Scholar 

  13. Storb R, Deeg HJ, Whitehead J, Appelbaum F, Beatty P, Bensinger W et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft-versus host-disease after marrow transplantation for leukemia. N Engl J Med 1986; 314: 729–735.

    Article  CAS  PubMed  Google Scholar 

  14. McSweeney PA, Storb R . Mixed chimerism: preclinical studies and clinical applications. Biol Blood Marrow Transplant 1999; 5: 192–203.

    Article  CAS  PubMed  Google Scholar 

  15. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  16. Ringden O, Remberger M, Persson U, Ljungman P, Aldener A, Andstrom E et al. Similar incidence of graft-versus-host disease using HLA-A, -B and -DR identical unrelated bone marrow donors as with HLA-identical siblings. Bone Marrow Transplant 1995; 15: 619–625.

    CAS  PubMed  Google Scholar 

  17. Aschan J, Ringden O, Andstrom E, Ljungman P, Lonnqvist B, Remberger M . Individualized prophylaxis against graft-versus-host disease in leukemic marrow transplant recipients. Bone Marrow Transplant 1994; 14: 79–87.

    CAS  PubMed  Google Scholar 

  18. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK . Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 2004; 20: 843–848.

    Article  PubMed  Google Scholar 

  19. Madara JL . Warner-Lambert/Parke-Davis Award lecture. Pathobiology of the intestinal epithelial barrier. Am J Pathol 1990; 137: 1273–1281.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Ohta K, Omura K, Hirano K, Kanehira E, Ishikawa N, Kato Y et al. The effects of an additive small amount of a low residual diet against total parenteral nutrition-induced gut mucosal barrier. Am J Surg 2003; 185: 79–85.

    Article  PubMed  Google Scholar 

  21. Hanson LA, Ahlstedt S, Andersson B, Carlsson B, Dahlgren U, Lidin-Janson G et al. Keynote address – Sixteenth National Meeting of the Reticuloendothelial Society San Antonio, Texas, December 5–8, 1979. The biologic properties of secretory IgA. J Reticuloendothel Soc 1980; 28: 1s–19s.

    CAS  PubMed  Google Scholar 

  22. Yang H, Kiristioglu I, Fan Y, Forbush B, Bishop DK, Antony PA et al. Interferon-gamma expression by intraepithelial lymphocytes results in a loss of epithelial barrier function in a mouse model of total parenteral nutrition. Ann Surg 2002; 236: 226–234.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Fowler DH, Gress RE . Th2 and Tc2 cells in the regulation of GVHD, GVL, and graft rejection: considerations for the allogeneic transplantation therapy of leukemia and lymphoma. Leuk Lymphoma 2000; 38: 221–234.

    Article  CAS  PubMed  Google Scholar 

  24. Hill GR, Crawford JM, Cooke KR, Brinson YS, Pan L, Ferrara JL . Total body irradiation and acute graft-versus-host disease: the role of gastrointestinal damage and inflammatory cytokines. Blood 1997; 90: 3204–3213.

    CAS  PubMed  Google Scholar 

  25. Reddy P, Ferrara JL . Immunobiology of acute graft-versus-host disease. Blood Rev 2003; 17: 187–194.

    Article  PubMed  Google Scholar 

  26. Mowat AM . Antibodies to IFN-gamma prevent immunologically mediated intestinal damage in murine graft-versus-host reaction. Immunology 1989; 68: 18–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Murai M, Yoneyama H, Ezaki T, Suematsu M, Terashima Y, Harada A et al. Peyer's patch is the essential site in initiating murine acute and lethal graft-versus-host reaction. Nat Immunol 2003; 4: 154–160.

    Article  CAS  PubMed  Google Scholar 

  28. Goldberg J, Jacobsohn DA, Zahurak ML, Vogelsang GB . Gastrointestinal toxicity from the preparative regimen is associated with an increased risk of graft-versus-host disease. Biol Blood Marrow Transplant 2005; 11: 101–107.

    Article  PubMed  Google Scholar 

  29. Murray SM, Pindoria S . Nutrition support for bone marrow transplant patients. Cochrane Database Syst Rev 2002; 2: CD002920.

    Google Scholar 

  30. Szeluga DJ, Stuart RK, Brookmeyer R, Utermohlen V, Santos GW . Nutritional support of bone marrow transplant recipients: a prospective, randomized clinical trial comparing total parenteral nutrition to an enteral feeding program. Cancer Res 1987; 47: 3309–3316.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden

    J Mattsson, S Westin & S Edlund

  2. Department of Clinical Immunology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden

    J Mattsson & M Remberger

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  1. J Mattsson
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  2. S Westin
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  3. S Edlund
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  4. M Remberger
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Correspondence to J Mattsson.

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Mattsson, J., Westin, S., Edlund, S. et al. Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease. Bone Marrow Transplant 38, 629–633 (2006). https://doi.org/10.1038/sj.bmt.1705493

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